Friday, June 27, 2014

C. Diff!

Every once in a while, the tables are turned and the physician becomes the patient. These times are typically very philosophical, because there is occasion for introspection on the part of the medical professional into medical care, psychology, and doctor-patient relationships.

A common problem on the medicine wards is Clostridium difficile diarrhea. Clostridium difficile ("C. diff") is an opportunistic bug that can colonize the colon without problems in normal people. When these normal people become people on antibiotics and the antibiotics kill the rest of their normal colon flora, C. diff takes over the abandoned real estate and causes a nasty diarrhea. Why am I telling you all this?

Because every once in a while, the tables are turned and the physician becomes the patient.

When my GI doc told me I had C. diff over the phone, I almost burst out laughing. I'm at high-risk because of my work in healthcare fields and my UC, but I had never thought that I would get it. C. diff was for people in bed and super sick, with or without a rectal tube.

But, walking and talking and functioning (and wondering why I was having problems) I had C. diff.

Patients who have C. diff are placed on contact isolation. So, for the duration of my illness I wore reversed contact isolation: I wore gloves everywhere and gowns when visiting patients. It was a nuisance. Happily, several of my patients were on contact isolation anyway, so I didn't feel quite so silly in the buoyant yellow paper things they call "gowns."

I'm a little tired to philosophize. But it's interesting and humbling.

Tuesday, June 24, 2014

The Radiology Department Believes in Protecting the Unborn

The radiology department at one of the outpatient clinics requires all women between 11-50 years old to sign a form to prevent "harmful" radiation to "unborn children." It's not fair to twist this into "the radiology department holds that there is a child at all times during pregnancy," but I can at least assert that the people who made this form believe in protecting people before birth. Just interesting.

Thursday, June 12, 2014

The Third Year Manifesto, last part: An Analysis

There are days that I want to ask the hospital at large: “When do I get my personhood back? When am I treated like I have the dignity that everyone else does?”

I want to be comfortable where I work. I want to be safe to be myself and express my limitations. Instead, I cork up dozens of questions a week. I’ve violated the sterile field a half dozen times and don’t bring it up. I hate being told that I can’t do something because being so uninvolved, it's not what I’m paying for, and I have more to offer. I hate being told that I can do something because I will be watched, I will fear derision and misunderstanding, I will fumble out of fear, I will put on my game face and fumble out of incompetence, or I will get lucky and be deluded so that the next fumble hurts more.

I want is to be satisfied with the way my life is going. I want the basic esteem of others. “Oh,” is all I wish that people would think when they saw me, “she’s a medical student. You know, those people can’t do much. But they sure try.”


Once, I caught myself apologizing to someone in these exact words:

“I’m so sorry for taking up so much space!”

After uttering this ridiculous sentence, I went out the nearest door in a polite rush. Only after the door shut behind me did I shake my head and think, “what a stupid thing to say. I’m taking my own personhood away; apparently, I don’t need anyone else’s help.”

So, now that it is the fourth year of medical school, I am deciding: no one is taking my dignity away, least of all me. If they demean me in the OR, they are doing something inappropriate. I will graciously excuse them, like one ignores a person passing gas.

I am determined never again to agree with the lie that I am a worthless idiot. That lie leads to an psychological hell.

Part of the reason I became such a doormat/basket-case of self-critical emotions and permitted everyone else’s criticisms (petty or cruel) to sink me, was that I had a lousy idea about humility. I had this glorified picture of religious life in somewhere between 1600 and 1900 in which saints were made by kissing floors. Didn’t St. Bernadette, St. Jeanne Jugan, St. Therese, and many others have to be grossly misunderstood and abused to become saints? Don’t you have to believe all the derogatory things people say about you if you want true humility? Yeah! So, I was excited because I’d heard (correctly) that the third year was a lot like a floor-kissing novitiate.

But there is a basic misunderstanding there. Cultures that file away at personal dignity crowd out holiness! A person tossed around in such a culture becomes so distraught over himself and convinced of his incapacity that he can’t have the magnanimity a saint needs to become like the all-loving God. Believing himself to be a microscopic locket—always too small, always wanting, always disappointing—this miserable man can’t imagine becoming a vault, a temple.

It is a lie of Satan that I am worthless. I want to do great things for God. I want God, I want to be like Him, and I expect He will make us that way. So if I ever stoop to another floor for a kiss, it will be because Jesus is there, waiting to kiss me back and make me His gorgeous, eternal, perfect bride.

Wednesday, June 11, 2014

Third Year Manifesto, Part 2: Stories

In which I vent all the stories that I've kept bottled up so as not to be a whiner. The last part of this trio of posts is coming tomorrow.


I obediently submitted to being taught how to insert a Foley every time I inserted one. Today (the first day of fourth year) was the first time no one approached me and said, “oh, let me show you how….” It was disorienting. Wasn’t someone going to smother me with their preferences?

I breathed. I felt free! But the freedom was not to last. As I proceeded, I heard a very distinct “hmpf!” behind me, in the same tone people use when they raise an eyebrow and say “well, that’s interesting!” and really mean something much less benign.


The first vaginal delivery I attended on L&D, I did what the clerkship director told me to do: I protected the perineum and stayed close, in case I could actually be allowed to deliver the baby. This is called, good-naturedly, “being aggressive,” and it’s a good quality in medical trainees.

In that first delivery, a senior resident and an intern were also there. I guess if I were more shrewd, I would have known that it was bound to be the intern’s delivery. But who was I to know that what the clerkship director told me wasn’t right?

The senior resident decided to put an end to my aggressiveness. She put her hand on my hands and pushed them away from the field. Pushed. No exaggeration; the equivalent force could have shoved a gallon of milk several feet. The embarassment (and the sheer force) moved me to the back table for the rest of the delivery. When she asked me later, “did you see how the baby did xyz during abc stage?” I felt like saying, “No, of course not. If you want me to see things, don’t push me away.”


When a gentler resident was graciously allowing me to suture subcutaneous tissue in the OR, I put my needle driver down on the field, with the needle still in it. It was the first time I had ever done this, because it was the first time I had to cut off my needle to tie. (It was the first time I wasn’t using 4-0 and subcuticulars in the skin). The scrub tech slapped my hand, chiding me verbally. I blushed with angry embarassment underneath my mask, but tractably apologized, etc. Then, she said these words exactly (I remember them and you’ll see why):

“There are some people,” she said self-righteously, “who’ll slap your hand for that. I won’t, but there are some.”

I tried not to stare at her blankly. I guess it never dawned on her that she, SHE had ACTUALLY (not metaphorically) slapped my hand. I guess people who use that phrase end up acting on it without realizing it?? She has been the only one to do that.


One day in surgery I learned that the scrub tech, the scrub-nurse-in-training, and I were all within a few years of each other. I was the oldest. I was paying, snipping, uncomfortable, and chastised during the surgery. The other two, who were allowed to take a lunch break (during this six-hour surgery), were paid and thanked.

The fact that I’m paying to be there seems to some surgeons to mean that I’m not to be thanked and that I’m automatically incompetent. It seems to say, “she can’t do anything.”

“No, no,” one surgeon said when I reached for a towel to drape a patient. The scrub tech, who had offered me the towel, knew me better than that surgeon. He was being a pal, and he knew I have seen patients draped dozens of times and I could do it. But no! “She’s a medical student, she doesn’t do that,” the surgeon said.

“Excuse me, Doctor Bossy-Pants,” I burned to say. “I am a medical student and I can do that. Watch!” But it’s her sterile field, it’s her OR time, I’m her responsibility and (the real reason) she’s grading me. So I didn’t do that. I backed down. I abased myself.

Tuesday, June 10, 2014

The Third Year Manifesto, Part 1: Cutting Suture

I will now discuss the stuff of third year that is not happy and glamorous. Having a blog places slight pressure on a person not to whine. But not to disclose the negative parts of medical school would be dishonest. So it’s time to air a few grievances, and (because I can’t seem to not do this) discuss morality and holiness at the same time.

At some point during my third year, I got very demoralized. It’s hard for a person who wants to do great things well (and is used to doing great things well) to find herself unable to hope even for mediocrity.

One response to this predicament: Ah, what a chance to grow in humility!

"Ah," goes this response, "I have had many peers, past and present, who have struggled to get the things I’ve gotten, like A’s and letters of recommendation and leadership positions and success…. Now, God is making me more like them, to help me see that they are my brothers in everything. I have nothing of my own and am happy to have God, because I truly lack nothing."

Another and much more human response to this predicament:
In its severest form, this disappointment becomes sadness, loneliness, isolation, depression, and despair.

It was a war between these two responses for the second half of third year. However, it is old news that 1) I am a little soul and 2) there's a war going on in me between holiness and not-holiness. God is exerting Himself to the maximum and employing all kinds of things (sacraments, virtues, habits, circumstances, living people, dead people, people I’ve never laid eyes on, angels, and even me) to make me like Himself. On the other side are all kinds of things (occasions, vices, habits, circumstances, living people, dead people, people I’ve never laid eyes on, angels, and especially me) persuading me to stay in my nice little hidey-self-in-hell-hole.

But morality aside for a teensy moment: seriously! This year was so demoralizing at times!

Do you have any idea what it is like to stand in a surgery, not allowed to do anything except trim suture? Somebody ties a knot around [whatever], and I come in with scissors and snip it. That is 90% of my intraoperative action. This is especially painful because I’ve been given great responsibility and responded rather well to in the past. I wish I could speak my mind in those ORs.

“You know, I am a person.”


“With an intellect.”


“A rather good intellect.”


“And I have pretty good hands, too. Did you know I paint? And I’m handy around the house.”


“And if you let me stick-tie the ovarian vessels/close the fascia/dissect adhesions/use a bovie/debride dead tissue/MANY OTHER EXAMPLES, I bet I could do it.”


The worst part is, I am not even permitted to stupidly cut as I like. I am chided because I am not doing it properly. Since the clinical years of medical school are a dizzying merry-go-round through services and surgeons, I can never acquire expertise in one thing. Many have pretened to, but no one ever has, given me a comprehensive lesson in how to properly cut all types of suture in all places according to the preferences of all surgeons. (I expect even the Eternal Father would have difficulty with this one. Just kidding, Abba.)

“Whoa!” says one surgeon. “Too short.”

Or again, the surgeon is uncomfortably silent after I cut. I timidly ask, “too long?”

At least I have never cut someone’s knot. There was once when I took the blame for a broken knot. A few minutes after I snipped, one of the resident’s knots came undone. To save the resident face, I said, “Oh, I cut your knot, didn’t I. I’m sorry.”

I became the queen of taking flak this year. There was an “Oh, thank you,” after every correction; there was a sincere-sounding “I’m sorry,” after every action someone objected to.

Today, while snipping, I grew less and less successful. I began to wonder whether there was a problem with the scissors. Surgeons and residents are quick to ask for a different instrument if the one they’re holding does something silly or inefficient. Not being a surgeon or a resident, I waited out my silly, inefficient instrument for a good five more snips. While I waited, a new scrub tech clocked in. This meant I lost the rapport I’d built up with the first one (my pulling a gown and gloves, helping in setup, etc) I didn’t think anything of this at the time, but now I wonder whether er shift change made a difference in the answer I received when I eventually asked, “Do you have another pair of scissors?”

There are at least four pairs of scissors in almost every set. I know because I know their names: curved Mayos, Mets, tenotomies. There are also Potts and Dietrichs, but even I wouldn’t use those for suture (now I’m just showing off how many types of scissors I can name without looking things up). The suture scissors are called “heavy sciz” by some, but their real name is straight Mayos. Technically, you’re supposed to use the straight Mayos for stuff, like foam, suture, and mesh. Cutting these undelicate things with the better scissors would dull the blades and damage tissue. But I’ve seen surgeons get frustrated with a pair of straight Mayos. They drop them to purposefully exclude them from use, then start to use the curved Mayo’s or the Mets. I’ve even seen someone use the tenotomies. So certainly it would not have been absurd for me to use a different pair of scissors. But what did the scrub tech say?

“Is it the scissors, or is it you?”

I felt like exploding.

Please,” I wanted to say, “even if it is me, could you think of a different way to say it? Maybe ‘show me how you’re cutting’? Or maybe, just maybe you could humor me? I humor people to ridiculous extent. Could you just hand me the curved Mayos? Maybe then I’ll learn that it is, in fact, not the scissors. And you know what else? Even if it’s not the scissors, I don’t like that you said ‘me,’ as if I/me/my person is a problem. My technique might be lousy, but why the ad hominem? Why do I become a problem because I don’t cut suture properly? And anyway, who has taught me how to cut? No one! I have had to cobble things together myself!”

See the med student, doing nothing?
Oh wait, I forgot to get them in the camera view.
But I said, smiling doormat that I have become, “Oh, probably me.” And she said what I should have been doing. My success was unchanged: some good cuts, some lousy ones. In retrospect I think the scissors were fine and I was fine. The problem was that the incision was getting deep (down to the retroperitoneum) and therefore the sutures were getting further and further away from me. When you have to stand on tiptoe and crane your neck and reach to cut something, nothing works quite as well. I can’t wait to be the surgeon or the resident and have a legitimate place to stand so that I can see the operative field all the time.